Skip to main content

Protocol for Lithium

Image
By


Step 1: First obtain a complete history (to confirm that lithium is indicated and suitable, there is no contraindication, identify whether the patient is taking any medications that interact with lithium, likely to adhere to treatment and the protocol)

Step 2: Physical examination especially blood pressure, pulse, weight, BMI, and thyroid examination

Step 3: Laboratory investigations especially TFTs, eGFR, ECG if needed, and in women of childbearing age, a pregnancy test. Serum calcium is also desirable.

Step 4: Education of the patient about the effects, side effects, the need for strict adherence, the risk of toxicity, signs of toxicity, and conditions that increase the risk of toxicity (in a way that generates a realistic and balanced view of the risks and advantages). Provide written materials Step 5: Start lithium OD200mg or 400mg. Aim for a plasma level of 0.4 to 0.8 mmol/L initially.

Step 6: Check plasma level after a week, then every two weeks until the plasma level is stable (target levels of about 0.4-0.8 mmol/dl). Step 7: If there is a suboptimal response, target a plasma level of up to 1mmol/L. Once a steady-state has been achieved, check every 6 weeks for some time. If no serious issues arise early then, check plasma lithium every 6 months

Step 8: Monitor for side effects history(esp. weight gain and fatigue) and lab investigations( Serum calcium, TFTs, and RFTs including eGFR) every six months.

Step 9: When planning to stop lithium, taper off gradually at a rate not more than 0.2mmol/L (plasma level)weekly.
Labels:

Comments

Post a Comment

Your Thoughts?

Popular posts from this blog

ADVOKATE: A Mnemonic Tool for the Assessment of Eyewitness Evidence

By
ADVOKATE: A Mnemonic Tool for Assessment of Eyewitness Evidence A tool for assessing eyewitness  ADVOKATE is a tool designed to assess eyewitness evidence and how much it is reliable. It requires the user to respond to several statements/questions. Forensic psychologists, police or investigative officer can do it. The mnemonic ADVOKATE stands for: A = amount of time under observation (event and act) D = distance from suspect V = visibility (night-day, lighting) O = obstruction to the view of the witness K = known or seen before when and where (suspect) A = any special reason for remembering the subject T = time-lapse (how long has it been since witness saw suspect) E = error or material discrepancy between the description given first or any subsequent accounts by a witness.  Working with suspects (college.police.uk)
Post a Comment
Read more

ICD-11 Criteria for Attention Deficit Hyperactivity Disorder (ADHD) 6A05

By
ICD-11 Criteria for Attention Deficit Hyperactivity Disorder (ADHD) 6A05 Attention deficit hyperactivity disorder is characterised by a persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity that has a direct negative impact on academic, occupational, or social functioning. There is evidence of significant inattention and/or hyperactivity-impulsivity symptoms prior to age 12, typically by early to mid-childhood, though some individuals may first come to clinical attention later. The degree of inattention and hyperactivity-impulsivity is outside the limits of normal variation expected for age and level of intellectual functioning. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organisation. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that re...
Post a Comment
Read more

ICD-11 Criteria for Depression (Recurrent Depressive Disorder) 6A71

By
ICD-11 Criteria for Depression (Recurrent Depressive Disorder) 6A71 Recurrent depressive disorder is characterised by a history or at least two depressive episodes separated by at least several months without significant mood disturbance. A depressive episode is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a Bipolar disorder. Inclusions:                Seasonal depressive disorder Exclusions:    ...
Post a Comment
Read more